Provider Demographics
NPI:1275835860
Name:SANDPIPER FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SANDPIPER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:MARCHIGIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-223-8001
Mailing Address - Street 1:13947 BEACH BOULEVARD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224
Mailing Address - Country:US
Mailing Address - Phone:904-223-8001
Mailing Address - Fax:
Practice Address - Street 1:13947 BEACH BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1270
Practice Address - Country:US
Practice Address - Phone:904-223-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL127461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty